Seese Laura, Schiff Mary, Olivieri Laura, Da Fonseca Da Silva Luciana, Da Silva Jose P, Christopher Adam, Harris Tyler H, Morell Victor, Castro Medina Mario, Rathod Rahul H, Kreutzer Jacqueline, Diaz Castrillon Carlos, Viegas Melita, Alsaied Tarek
Faculty Pavilion, Suite FP5210, UPMC Children's Hospital of Pittsburgh, 4401 Penn Avenue, Pittsburgh, PA 15224-1334, USA.
J Clin Med. 2025 Jun 9;14(12):4067. doi: 10.3390/jcm14124067.
To explore the differences in exercise capacity between the extracardiac conduit (ECC) and lateral tunnel (LT) Fontan. 2169 patients (36% LT ( = 774); 64% ECC ( = 1395)) underwent a Fontan operation between 2000 to 2023 in a multi-institutional Fontan registry. LT patients were age-matched to ECC patients, and cardiopulmonary exercise test (CPET) results were compared. Following age-matching and exclusion of those without CPET data, 470 patients emerged with 235 LT and 235 ECC patients. ECC achieved higher peak heart rates (174 vs. 169 bpm, = 0.0008) and heart rates at ventilatory anaerobic threshold (VAT) (130 vs. 119 bpm = 0.0005). Oxygen saturations at peak (93.0 vs. 90.0%, = 0.0003) and baseline (95 vs. 92.5%, < 0.0001) were higher in the ECC group. The VO at VAT was higher in the ECC (17.8 vs. 16.4 mL/kg/min = 0.0123). Baseline pre-exercise heart rate, peak oxygen pulse, VE/VCO slope, peak VO, peak % of predicted VO, peak work rate, and peak % of predicted work rate were similar (all, > 0.05). Notably, less than 35% of the cohort had a documented CPET. We found that the ECC performed statistically better on many parameters of exercise capacity, including the ability to increase heart rate, have higher peak and baseline saturations, and to achieve superior VO at VAT. However, the magnitude of difference was small, suggesting that the translational value into the clinical realm may be limited. With a minority of the registry patients having CPET completed, this illuminates the need for the implementation of CPET surveillance for Fontan patients.
为探究心外管道（ECC）Fontan手术和侧隧道（LT）Fontan手术患者运动能力的差异。2000年至2023年期间，2169例患者（36%为LT（n = 774）；64%为ECC（n = 1395））在多机构Fontan登记处接受了Fontan手术。LT组患者与ECC组患者年龄匹配，并比较了心肺运动试验（CPET）结果。在年龄匹配并排除无CPET数据的患者后，最终纳入470例患者，其中LT组235例，ECC组235例。ECC组患者达到了更高的峰值心率（174次/分钟 vs. 169次/分钟，P = 0.0008）和通气无氧阈（VAT）时的心率（130次/分钟 vs. 119次/分钟，P = 0.0005）。ECC组患者在峰值时（93.0% vs. 90.0%，P = 0.0003）和基线时（95% vs. 92.5%，P < 0.0001）的血氧饱和度更高。ECC组患者在VAT时的VO₂更高（17.8 mL/kg/min vs. 16.4 mL/kg/min，P = 0.0123）。运动前基线心率、峰值氧脉搏、VE/VCO₂斜率、峰值VO₂、预测VO₂峰值百分比、峰值工作率以及预测工作率峰值均相似（均P > 0.05）。值得注意的是，队列中记录了CPET结果的患者不到35%。我们发现，在运动能力的许多参数方面，ECC组在统计学上表现更好，包括提高心率的能力、更高的峰值和基线血氧饱和度，以及在VAT时达到更高的VO₂。然而，差异幅度较小，这表明其在临床领域的转化价值可能有限。由于登记处中只有少数患者完成了CPET检查，这凸显了对Fontan患者实施CPET监测的必要性。
